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Wellens Syndrome: Single Centre Study and Literature Review

Anamaria Avram
Anamaria Avram
, 
Alexandru Iancu
Alexandru Iancu
, 
Radu C. Brezeanu
Radu C. Brezeanu
, 
Valentin Chioncel
Valentin Chioncel
, 
Cătălina L. Andrei
Cătălina L. Andrei
 und 
Crina Sinescu
Crina Sinescu
   | 31. Dez. 2022
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Article Category: Original Article
Online veröffentlicht: 31. Dez. 2022
Seitenbereich: 203 - 209
DOI: https://doi.org/10.2478/rjc-2022-0036
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© 2022 Anamaria Avram et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Main studies regarding Wellens sign/syndrome. BP = blood pressure; CA = coronary angiography; CAD = coronary artery disease; CV = cardiovascular; DM = diabetes mellitus; FU = follow up; UA = unstable angina

Author (country), year and journal Study population (enrollment period) Study type Objectives Follow-up period Key results
de Zwaan et al (Netherlands), 1982, Am Heart J 5 145 consecutive pts with UA, of which 26 pts with Wellens sign (not specified) Observational study ≥ 90% coronary stenosis at CA 7,5 months (mean) Of the 13 pts with Wellens sign that underwent CA, 12 had critical LAD stenosis.
Heines DE et al (USA), 1983, Am J Cardiol19 118 consecutive pts with UA, of which 40% had new negative T waves (march 1980 – august 1982) Retrospective study Distribution and severity of CAD. Prognostic implications in pts treated conservatively or surgically. 19±9 months Of the 73 pts who underwent CA, 56 had a ≥70% stenosis of one or more coronary arteries, 3 had a 50–70% stenosis of a single coronary artery, 2 had a <50% stenosis of a single coronary artery, and 12 had no coronary artery disease.Of the 71 pts treated conservatively in the study group, 10 had cardiac events (3 pts developed MI and 1 died suddenly) during FU. In the control group, 7 of the 45 pts treated conservatively had cardiac events (4 pts developed MI and 3 died suddenly) (p < 0,05).Of the 41 pts treated surgically in the study group, 3 developed MI and 1 died suddenly. The incidence of cardiac events did not differ from the control group.
de Zwaan et al (Netherlands), 1989, Am Heart J 17 180 consecutive pts with UA and Wellens sign (1st july 1980 – 31st december 1985) Prospective diagnostic cohort study Angiographic characteristics 1,5 y after the enrollment of the last pt 33 pts with LAD occlusion and 147 pts with 50–99% (mean 85%) LAD stenosis.
Forselv GC and Vik-Mo H (Norway), 2007, J of the Norw Med Assoc22 138 consecutive pts with NSTEACS (15th august 2005 – 31st january 2006) Prospective diagnostic cohort study The diagnostic accuracy of ECG changes for detecting ≥ 50% proximal LAD stenosis none Negative/biphasic T waves in V2–V3 has a Sen of 76%, a Spe of 89%, a PPV of 61% and a NPV of 94% for detecting proximal LAD stenosis.
Akhtar et al (Pakistan, 2012, J Pak Med Assoc18 100 pts with UA and biphasic T waves that underwent CA (february 2010 – november 2010) Prospective diagnostic cohort study The capacity of ECG changes to detect ≥ 70% LAD stenosis.Comparison of the subgroup of pts with biphasic T waves in V2–V3 with those with biphasic T waves in V2–V4. none 93 pts had LAD culprit lesion, meaning a PPV of 93%. In the subgroup of pts with biphasic T waves in V2–V3 the PPV was 100%, while in the subgroup of pts with biphasic T waves in V2–V4 the PPV was 37,5%.
Kobayashi A et al (SUA), 2015, JACC: Cardiovasc Interv20 424 consecutive pts with NSTEMI who underwent CA within 5 days after presentation, of which 18 pts (4,2%) with Wellens sign Retrospective diagnostic cohort study Localization of the culprit lesion.Major cardiac events at 30 days. 30 days Of the 18 pts with Wellens sign, 9 had LAD culprit lesion (PPV 50%).There were no statistically significant differences between the two groups regarding major cardiac events at 30 days.
Pandharinath JD et al (India), 2016, Ind J of Research27 40 pts with WS (january 2011 – december 2011) Descriptive study Clinical profile of the pts with WS: risk factors, clinical presentation, angiographic characteristics none CV risk profile: 25% pts with high BP, 37,5% pts with DM, 50% pts with dyslipidemia, 35% pts current smokers, 32,5% pts with history of premature CAD.Angiographic characteristics: 35 pts (87,5%) with single vessel disease, 2 pts (5%) with two vessel disease and 3 pts (7,5%) with normal coronary arteries. LAD disease was present in all 37 pts who had CAD.
Liu M et al (China), 2016, International J Cardiol 24 275 consecutive pts with UA, of which 35 pts with WS Retrospective study Analysis of the clinical characteristics of pts with WS.Corelation of the WS in the leads DII, DIII and aVF with a significant stenosis of the dominant artery. none The prevalence of WS was 12,73% (35 pts), of which 34,3% had type A WS. There were no significant differences between WS group and control group regarding clinical and biological parameters.The Sen and Spe of Wellens sign in V2–V3 for predicting a severe LAD stenosis was 18,92% and 96,67%, respectively. 20 pts (7,3%) had Wellens sign in DII, DIII and aVF, of which 16 had a ≥ 50% stenosis of the dominant artery. The Sen of Wellens sign in DII, DIII and aVF for predicting a severe RCA/Cx stenosis was 9,5% and the Spe was 96,3%.
Alderwish et al (SUA), 2018, Circ: Cardiovasc Quality and Outcome 25 431 pts who underwent CA (january 2009 – december 2011) Retrospective study Sen and Spe of Wellens sign for the diagnosis of significant (≥70%) or critical (≥90%) proximal LAD stenosis. none The Sen, Spe, PPV and NPV of Wellens sign for the diagnosis of critical LAD stenosis was 65,4%, 69,2%, 51,5% and 80%, respectively.The Sen, Spe, PPV and NPV of Wellens sign for the diagnosis of significant LAD stenosis was 50%, 69,4%, 65,6% and 54,3%, respectively.
Bandara et al (Sri Lanka), 2018, International J Recent Scient Res21 30 pts with WS who underwent CA (2017) Descriptive study Echocardiographic and angiographic characteristics.The rate of residual angina, reinfarctization and mortality at 90 days. 90 days Prevalence of type A WS: 40%. PPV of Wellens sign: 86%. Mean LVEF: 57,9%±9,8%. Mean LVWMSi: 1,04±0,07. Echocardiographic parameters could not predict significant LAD stenosis. 22 pts (70%) had critical (≥90%) LAD stenosis. All of the pts who had critical LAD stenosis were treated with PCI.At 90 days none of the pts treated with PCI had residual angina or reinfarctization and none died.
Kobayashi A et al (SUA), 2019, Cardiol Res23 274 pts with NSTEMI who underwent CA, of which 24 (8,8%) with Wellens sign (january 2013 – june 2014) Retrospective study Prevalence of LAD culprit artery.In-hospital mortality and recurrent MI. none 66,7% of the pts with Wellens sign had LAD culprit artery. The Sen and Spe of Wellens sign for predicting LAD culprit lesion was 24,6% and 96,2%, respectively.The rate of in-hospital death and recurrent MI was similar between the two groups.
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